Messages to the Editor
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Addressing the article entitled “Migraine’s Supply/Demand Problem” in our Spring 2022 issue Ms. Pam Nice writes…
One aspect not covered in the article was the difficulty of getting affordable recent medications for migraine. The designer drugs sound great, and some have worked perfectly well for me. I know this because my doctor has given me samples to try. However, they are unaffordable with my insurance coverage. Eight pills of Nurtec, for instance, which cost me almost $800, even after coverage was granted through a physician request. I actually spend more time with my neurologist because we are trying to find some older medications that might work. No luck so far. Big Pharma is also a player in this supply/demand crisis.
Ms. Nice,
With apologies for mixing my metaphors, you are “preaching to the choir” to “stop dancing with the Devil”.
It is a travesty that in America we continue to provide our citizens with vastly different levels of healthcare while recording public health outcomes inferior to those of many nations that have made an effort to adopt and implement “socialized” medicine wherein ability to pay does not influence quality of care received. Shameful. Even in a nation which seeks simultaneously to embrace the often contradictory goals of a social democracy and capitalistic economy every citizen deserves an equal shot at healthcare.
I have no particular interest in participating as a member of a society where “from each according to his capabilities and to each according to his needs” is the prevailing ethos. I am no fan of our prevailing culture’s reflexive worship of “equity”, a culture which appears to celebrate and reward victimhood. “Deserve” is a word best used sparingly and with caution, and to implicate that every citizen “deserves” a home, “deserves” a salary independent of individual effort and productivity or “deserves” admission to a prestigious university is simply wrongheaded. But healthcare is different.
I chose a career in medicine in large part because the prospect of treating (literally treating) all my fellow citizens as “equal” and doing so with colleagues who were similarly dedicated to the common good was powerfully attractive. To work as a clinical neuroscientist, to help develop new therapies for stroke and headache that were proven by rigorous research to be safe, tolerable and effective and then to see those therapies benefit patients in general clinical practice has been tremendously rewarding. To watch as only a subpopulation of my own patients may have access to those therapies as a function of their insurance coverage or their ability to manage large co-pays has been profoundly dismaying.
I hear you, Ms. Nice, and my like-minded medical provider colleagues hear you. Unless our government, the insurers and the pharmaceutical industry can arrive at some new paradigm that at least approximates the type of healthcare delivery system which should exist in a true social democracy, I can assure you we will NOT continue to accept the current status quo. For more on this please see “Dancing with the Devil” on page 8 of this issue.
— John Farr Rothrock, MD
Also… In regards to our Spring 2022 issue’s article entitled “Non-Pharmacologic Treatment of Migraine”, another reader wrote to express her wish that we had focused some of the article’s content on postmenopausal women dealing with difficult to control migraine.
An appropriate request. As I age myself, I realize all too well that the old “youth is wasted on the young” cliché is paired with the inescapable fact that in a culture such as ours one becomes increasingly invisible with aging. Those whose chronologic ages range on the “far side of middle age” (my attempt to avoid the pejorative category of “elderly”) often are left on the outside looking in…especially in regards to a disorder such as migraine whose target demographic is females ages 15-45 but is hardly restricted to that gender or age range.
As we have emphasized many times in the pages of this magazine, nothing is ever “always” in migraine. For example, while it’s true that many females enjoy a welcome reduction in migraine burden following the onset of menopause, I have treated many patients whose migraine either worsened following menopause or, in some cases, first emerged at that time. While the article the reader refers to was composed to focus primarily on how to treat migraine with non-pharmacological interventions, and while there’s obviously not a great deal to be done about aging, she is quite correct in pointing out that there exists a large subpopulation of post-menopausal females who are suffering with migraine. In future issues we will devote content addressing the needs of that subpopulation.
— John Farr Rothrock, MD
